J7516 Inj, cyclosporine 250mg

Injection, cyclosporine, 250 mg

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for J7516

Medicare Part B drug payment limit (ASP, October 2026)

J7516 payment limit: $75.649 per 250 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J7516 (CMS ASP NDC-HCPCS crosswalk, October 2026)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J7516

0 of 1 payer prior-auth lists that name J7516 require prior authorization or set conditions.

Payer coverage policies that name J7516

J7516 appears in 22 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaAdalimumab (0655)
Anakinra (Kineret), Rinvoq, Otezla and Xeljanz, Clindamycin, Metronidazole, Rifampicin, Sulfasalazine, Leflunomide -		listed, no stanceJul 13, 2026payer document
AetnaAnifrolumab-fnia (Saphnelo) (0997)listed, no stanceJun 5, 2026payer document
AetnaBelimumab (Benlysta) (0818)listed, no stanceJun 10, 2026payer document
AetnaEculizumab (0807)listed, no stanceAug 11, 2026payer document
AetnaEmapalumab-lzsg (Gamifant) (0948)listed, no stanceDec 8, 2025payer document
AetnaExtracorporeal Immunoadsorption (Prosorba Column) (0355)listed, no stanceMay 26, 2026payer document
AetnaGolimumab (Simponi and Simponi Aria) (0790)listed, no stanceJul 31, 2026payer document
AetnaGuselkumab (Tremfya) (1011)listed, no stanceJun 29, 2026payer document
AetnaHypoxic Ischemic Encephalopathy (0812)
Topiramate		not coveredNov 20, 2025payer document
AetnaInebilizumab-cdon (Uplizna) (0975)listed, no stanceAug 11, 2026payer document
AetnaInfliximab (0341)listed, no stanceOct 5, 2026payer document
AetnaMultiple Sclerosis (0264)
Serum neurofilament, Osteopontin, Clemastine fumarate, Intravesical vanilloids, cannabis and cannabinoids		not covered (range J7515-J7516)Sep 10, 2026payer document
AetnaNipocalimab-aahu (Imaavy) (1083)listed, no stanceAug 11, 2026payer document
AetnaNon-myeloablative Hematopoietic Cell Transplantation (Mini-Allograft / Reduced Intensity Conditioning Transplant) (0634)listed, no stanceSep 25, 2026payer document
AetnaPlasmapheresis/Plasma Exchange/Therapeutic Apheresis (0285)listed, no stanceApr 16, 2026payer document
AetnaRavulizumab-cwvz (Ultomiris) (0946)listed, no stanceAug 11, 2026payer document
AetnaRisankizumab-rzaa (Skyrizi) (1009)listed, no stanceJul 1, 2026payer document
AetnaRituximab (0314)listed, no stanceSep 15, 2026payer document
AetnaRozanolixizumab-noli (Rystiggo) (1035)listed, no stanceAug 11, 2026payer document
AetnaSpesolimab-sbzo (Spevigo) (1013)listed, no stanceApr 2, 2026payer document
AetnaTildrakizumab-asmn (Ilumya) (1012)listed, no stanceJul 1, 2026payer document
AetnaUstekinumab (0912)listed, no stanceJul 1, 2026payer document

Recent prior-auth changes

  • Apr 1, 2025: PA removed, UnitedHealthcare
  • Mar 1, 2025: PA added, UnitedHealthcare
  • Jan 1, 2025: PA removed, UnitedHealthcare

Medicaid fee-for-service

  • AZ: $75.65 (outpatient_hospital), effective Jul 1, 2026
  • IL: $74.20 (practitioner), effective Apr 1, 2026
  • IN: $34.90 (professional, Advanced Practice Nurse (85%), non-facility), effective Oct 1, 2017
  • KS: $75.65 (default), effective Jul 1, 2026
  • KY: $0.00 (asc), effective Jan 1, 2026
  • NE: $75.64 (injectables), effective Jul 1, 2026
  • OH: $75.65 (provider_administered_drugs), effective Jul 1, 2026
  • OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
  • TX: $73.68 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2026
  • VA: $75.64 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $75.65 (professional_administered_drugs), effective Jul 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.